Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China.
Department of Cardiothoracic Surgery, UMC Utrecht, Utrecht, The Netherlands.
World J Pediatr Congenit Heart Surg. 2024 Sep;15(5):562-570. doi: 10.1177/21501351241236742. Epub 2024 Jul 25.
To examine the probability of left ventricular outflow tract (LVOT) reintervention following interrupted aortic arch (IAA) repair in neonates with LVOT obstruction (LVOTO) risk. This retrospective multicenter study included 150 neonates who underwent IAA repair (2003-2017); 100 of 150 (67%) had isolated IAA repair (with ventricular septal defect closure) and 50 of 150 (33%) had concomitant LVOT intervention: conal muscle resection (n = 16), Ross-Konno (n = 7), and Yasui operation (n = 27: single-stage n = 8, staged n = 19). Demographic and morphologic characteristics were reviewed. Factors associated with LVOT reoperation were explored using multivariable analysis. Concomitant LVOT intervention was more likely in neonates with type B IAA, bicuspid aortic valve, aberrant right subclavian artery, smaller aortic valve annulus, and ascending aorta dimensions. On follow-up, five-year freedom from LVOT reoperation was highest following Ross-Konno (100%), 77% following Yasui (mainly for neo-aortic regurgitation), 77% following isolated IAA repair (mainly for LVOTO), and 47% following IAA repair with concomitant conal resection, = .033. While all patients had low peak LVOT gradient at time of discharge, those who had conal resection developed higher gradients on follow-up ( = .007). Ross-Konno and Yasui procedures were associated with higher right ventricular outflow tract (RVOT) reoperation. In the cohort following isolated IAA repair, aortic sinus Z score was associated with LVOT reoperation. Both Yasui and Ross-Konno operations effectively mitigate late LVOTO risk. The highest risk of reintervention for LVOTO was associated with conal muscle resection while the lowest risk is associated with Ross-Konno. The RVOT reoperation risk in patients who had Ross-Konno or Yasui does not seem to affect survival.
探讨左心室流出道（LVOT）在新生儿左心室流出道梗阻（LVOTO）风险的主动脉弓中断（IAA）修复后再干预的可能性。本回顾性多中心研究纳入了 150 例接受 IAA 修复的新生儿（2003-2017 年）；150 例中有 100 例（67%）接受单纯 IAA 修复（伴室间隔缺损闭合），50 例（33%）接受 LVOT 联合干预：圆锥肌切除术（n=16），Ross-Konno（n=7）和 Yasui 手术（n=27：单阶段 n=8，分期 n=19）。回顾了人口统计学和形态特征。使用多变量分析探讨与 LVOT 再次手术相关的因素。在伴有 B 型主动脉弓、二叶式主动脉瓣、右锁骨下动脉异常、主动脉瓣环较小和升主动脉尺寸较小的新生儿中，更可能进行 LVOT 联合干预。随访时，Ross-Konno 的 5 年无 LVOT 再手术率最高（100%），Yasui 为 77%（主要为新主动脉瓣反流），单纯 IAA 修复为 77%（主要为 LVOTO），IAA 修复伴圆锥肌切除术为 47%，=0.033。虽然所有患者在出院时的 LVOT 峰压差均较低，但行圆锥肌切除术的患者在随访时出现更高的梯度（=0.007）。Ross-Konno 和 Yasui 手术与较高的右心室流出道（RVOT）再手术相关。在接受单纯 IAA 修复的队列中，主动脉窦 Z 评分与 LVOT 再手术相关。Yasui 和 Ross-Konno 手术均可有效降低晚期 LVOTO 风险。LVOTO 再干预风险最高与圆锥肌切除术相关，风险最低与 Ross-Konno 相关。接受 Ross-Konno 或 Yasui 手术的患者 RVOT 再手术风险似乎不会影响生存。
